Provider Demographics
NPI:1790183671
Name:ROANOKE WELLNESS CENTER
Entity type:Organization
Organization Name:ROANOKE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:SPRUILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-772-8043
Mailing Address - Street 1:4346 STARKEY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0605
Mailing Address - Country:US
Mailing Address - Phone:540-772-8043
Mailing Address - Fax:540-772-8242
Practice Address - Street 1:4346 STARKEY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0605
Practice Address - Country:US
Practice Address - Phone:540-772-8043
Practice Address - Fax:540-772-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty